The outcome of older adults with classic Hodgkin lymphoma in British Columbia

Abstract

Outcomes in older adults with classical Hodgkin lymphoma (cHL) have traditionally been poor, in part related to poor tolerance to standard chemotherapy. Herein, we evaluated the survival of patients aged >60 years with cHL in British Columbia in a population-based analysis. From 1961 to 2019, 744 pa-tients with newly diagnosed cHL were identified. With a median follow-up of 9 years, 5-year disease specific (DSS) and overall survival (OS) have improved by decade comparison (both p<0.001), remain-ing stable in the past 20 years (DSS p=0.35; OS p=0.26). In the modern management era (2000-present), 361/401 patients (90%) received active therapy for cHL and had a 5-year OS of 60%. For those who received curative intent therapy (n=327), the 5-year progression-free survival (PFS), OS and DSS were 60%, 65%, and 76%, respectively and estimates were superior in those 60-69 y (72%, 77%, 83%) compared with those 70-79 y (54%, 57%, 70%) and >80 (28%, 39%, 63%) (p<0.05 for all). Overall, pul-monary toxicity occurred in 58/279 (21%) of bleomycin-treated patients, with 22/58 (38%) occurring after cycles 1 or 2, accounting for 8/20 (40%) of treatment-related deaths. Outcomes in older adults with cHL have improved in recent decades however, they remain poor for those >70 even in the mod-ern treatment era. Further, treatment-related toxicity remains a significant concern and use of bleo-mycin should be avoided in most patients.

Impact of Preexisting Heart Failure on Treatment and Outcomes in Older Patients With Hodgkin Lymphoma

“…In addition, observational studies suggest that anthracycline-free regimens are associated with worse lymphoma outcomes for both lymphoma types. 7 , 23 , 24 , 25 , 26 …”

“… 33 Although novel agents may eventually eliminate the need for anthracyclines, at the present time, anthracycline-based regimens are associated with better lymphoma outcomes even in older patients with comorbidities, although further studies are needed to assess optimal regimens for patients with pre-existing HF, multiple comorbidities, or documented geriatric syndrome. 7 , 23 , 24 …”

Overall survival and causes of death in elderly patients with Hodgkin lymphoma: a Norwegian population-based case-control study

“…This is in line with the 5% TRM reported in a population-based study in British Columbia, Canada, also in the modern era, but the latter study provided no clear definition of TRM. 28 Prospective studies of combination chemotherapy in elderly HL patients have reported rates ranging from 7% to 18%. 14 , 15 , 27 , 30 Regimens that include novel drugs, such as brentuximab vedotin or programmed cell death protein-1 inhibitors are also studied in selected elderly patients.…”

“…38 Corresponding numbers in the British Columbia cohort treated since 2000, where 160 deaths had occurred in the 327 patients treated with curative intent, were 49.4% for deaths from HL (including deaths from immediate treatment toxicity), 19.4% for secondary malignancies (including other hematologic malignancies), and 8.8% for CVD, all possibly more representative comparators to our data. 28 …”

“…Altogether, OS of our curative cohort was similar to the equally large and also population-based study from British Columbia, both with a 5-year OS rate of 60%, treated with ABVD. 28 Concerns have been raised about exaggerated risks of pulmonary toxicity from bleomycin in the elderly. Five patients in our cohort (7% of those treated with ABVD in the curative group) died of pulmonary toxicity possibly associated with bleomycin.…”